The Answer is to Empower, not Attack, the World Health Organization

As COVID-19 began to roll across China, leaving thousands dead and catapulting a pathogen on a lethal global trajectory, President Donald Trump had nothing but praise for China’s response and President Xi Jinping. On Jan. 24, Trump tweeted, “China has been working very hard to contain the Coronavirus. The United States greatly appreciates their efforts and transparency … In particular, on behalf of the American People, I want to thank President Xi!”

By Jan. 31st, Trump had announced a partial travel ban from China, but he still downplayed the risk of the virus, declaring as late as Feb. 24 that the situation was “very much under control.” As COVID-19 fanned out across the United States, it became clear that Trump’s wishful thinking had left the country dangerously vulnerable.

Only after the spiking number of U.S. infections made the public health crisis impossible to ignore did President Trump leap into action – to find a scapegoat to blame for his negligence. China, of course, would have been an obvious target. But making China the stooge was difficult given Trump’s repeated praise for Xi’s handling of the crisis. So, Trump needed another patsy. And he quickly found one: the World Health Organization. The president and his right-wing media chorus began to argue that the World Health Organization was ultimately to blame for its failure to challenge Xi’s mishandling of the virus and for helping to paper over the seriousness of the epidemic in the critical early days.

This was grade school-caliber deflection. It was Trump himself, echoing Xi’s own propaganda, who was one of the most prominent voices praising China’s response to the virus throughout January and into early February. The World Health Organization did convey the information they received from China, though too uncritically, while they negotiated permission to get their own team inside the country to make an independent assessment. But by January 29, the WHO was warning the whole world to take action to prepare for the spread of the virus.

Meanwhile, as late as Feb. 7, when cases had already been discovered in the United States, Trump was still claiming that Xi had “handled it really well.” On 12 separate occasions during January and February, he repeated Chinese talking points. And it was Trump, not the World Health Organization, who led the chorus of skeptics downplaying the threat from COVID-19. The World Health Organization should have been more skeptical of China’s early assertions, but as an organization dependent on the support of its member states, it would be difficult to contradict its two most powerful members.

Nevertheless, to distract from Trump’s praise for China, and his gross overconfidence, the president and his allies simply decided to claim that it was the WHO, not Trump or Xi, who deserved the blame. And then last week, he took his campaign to discredit the World Health Organization even further, halting U.S. funding in order to place a clearly marked political scarlet letter on the WHO.

The Irreplaceability of the World Health Organization

It should go without saying that it is extremely dangerous to suddenly pull funding from the world’s largest public health organization in the middle of a global pandemic.

The World Health Organization is critical to stopping disease outbreaks and strengthening public health systems in developing countries, where COVID-19 is starting to appear. Yemen announced its first infection earlier this month, and other countries in Africa, Asia and the Middle East are at severe risk. Millions of refugees rely on the World Health Organization for their health care, and millions of children rely on the WHO and UNICEF to access vaccines.

The World Health Organization is not perfect, but its team of doctors and public health experts have had major successes. Their most impressive claim to fame is the eradication of smallpox – no small feat. More recently, the World Health Organization has led an effort to rid the world of two of the three strains of polio, and they are close to completing the trifecta.

These investments are not just the right thing to do; they benefit the United States. Improving health outcomes abroad provides greater political and economic stability, increasing demand for U.S. exports. And, as we are all learning now, it is in America’s national security interest for countries to effectively detect and respond to potential pandemics before they reach our shores.

As the United States looks to develop a new global system of pandemic prevention, there is absolutely no way to do that job without the World Health Organization. Uniquely, it puts traditional adversaries – like Russia and the United States, India and Pakistan, or Iran and Saudi Arabia – all around the same big table to take on global health challenges. It has relationships with the public health leaders of every nation, decades of experience in tackling viruses and diseases, and the ability to bring countries together to tackle big projects. This ability to bridge divides and work across borders cannot be torn down and recreated – not in today’s environment of major power competition – and so there is simply no way to build an effective international anti-pandemic infrastructure without the World Health Organization at the center.

Trump’s team likely knows this, but they see an opportunity to attack the World Health Organization because of the increasing influence that China has inside the organization. But China’s increasing presence in the WHO is, frankly, of Trump’s making. Like many international organizations, the World Health Organization has watched as over the last three years the United States has disappeared from the global playing field and mercilessly attacked multinational institutions. China, on the other hand, has done the opposite. Sensing the vacuum created by the Trump administration’s global retreat, China has dramatically scaled up its diplomatic presence all over the world and its level of participation and focus on international organizations like the World Health Organization. Yes, the United States still contributes far more to the organization than China. But China’s contributions have grown by 50 percent since 2014, and the world understands which way the wind is blowing. A second Trump term could mean dramatically reduced U.S. funding or the wholesale withdrawal of America from the World Health Organization and other international organizations.

So it is true that the World Health Organization may now be more deferential to China as a growing benefactor. And it is also true that this deference likely contributed to the international body’s downplaying the seriousness of the epidemic in the early days, making embarrassing statements about Taiwan’s response to the virus, and waiting too long to officially declare COVID-19 a pandemic. The World Health Organization should not be let off the hook for these early mistakes. But the organization would have felt less compelled to acquiesce to China had Donald Trump, the leader of the free world, not been doing the exact same thing. And frankly, few in the United States noticed or cared about the World Health Organization’s statements on COVID-19 early on because Trump was fully occupying the lane reserved for China apologists and COVID-19 skeptics.

A New World Health Organization We Deserve, With Renewed American Leadership

How the United States and other countries behave in the wake of COVID-19 may well determine how the coming decades unfold. There will be a strong temptation to see the spread of this deadly virus as an argument for reclusiveness and self-reliance. This sentiment is understandable and even has some merit. For instance, America shouldn’t be so reliant on China and other nations for critical medical supplies. But it would be a mistake to take this line of thinking too far. A world where countries become suspicious of one another and are driven to mercantilism, militarism, and xenophobia, will be a much poorer and more dangerous place.

Rather than seeing COVID-19 as an argument for isolationism, governments should be focused on how we work together to defeat it and epidemics like it. A White House that was sufficiently motivated could push reforms at the World Health Organization that would make it a stronger and more impactful institution. Trump is doing the opposite – walking away and effectively begging China to fill the space left open by America’s departure. The president is missing a major opportunity to stay at the table and use this moment of international crisis as the leverage to create real reform at the World Health Organization.

First, the United States should be enhancing, not tearing down, the World Health Organization’s legitimacy. The body has global reach, including rare access in places like Yemen, Libya, and Syria, but it is not all-powerful. We first need to clarify the body’s mandate. Responding to novel and global pandemics like H1N1, Ebola, or COVID-19 was not foreseen by its founders. In fact its constitution doesn’t mention the word pandemic, merely giving it the role of the “directing and coordinating authority on international health work” including “epidemic, endemic and other diseases.”

On top of that, the body’s recommendations are not considered binding and the World Health Organization has no ability to compel or sanction its members. After it declared a public health emergency for COVID-19, many countries, including the United States, didn’t listen. China refused to provide the World Health Organization with much-needed data for critical weeks. The United States could take the lead, through the World Health Organization, to reform the International Health Regulationsand develop new international legal enforcement tools to make sure no country can ever again get away with hiding information about a deadly virus. While giving the World Health Organization the ability to enact and enforce binding resolutions would be an uphill battle, the stakes of inaction are clear.

Second, member states have decided to under-resource and tie the hands of the World Health Organization. We can undo that. Its annual budget of approximately $2.4 billion is less than one-third that of the U.S. Centers for Disease Control and Prevention and is less than 36 hours’ worth of U.S. defense spending. No wonder the World Health Organization cannot do everything we expect of it. Without an increase in funding, the World Health Organization will be unable to respond to this outbreak or prepare for the next global health emergency. But it’s also about flexibility. Currently, 75 percent of the organization’s budget is earmarked by donors. This reduces the space for innovative thinking to prevent and prepare for the next crisis. The over-reliance on voluntary contributions makes the World Health Organization hesitant to criticize any donor states, including China. The United States should lead an appeal for all countries to fully pay their dues and to reduce these earmarks.

Third, the World Health Organization must improve coordination between leadership and its regional offices. The heads of the body’s regional offices are political appointees elected by member states in their respective region, with significant budget powers independent of the organization’s headquarters. The 2014 Ebola crisis revealed that this system empowered officials in the regional office who were influenced by political considerations of member states over the World Health Organization’s public health imperatives, and delayed the declaration of a public health emergency by two months. This system is maddening, but instead of throwing up our hands in frustration, the United States could use its diplomatic and financial muscle to prompt reform.

Lastly, a reformed World Health Organization ought to address access to highly in-demand vaccines. We know that when a COVID-19 vaccine is developed, every country will want to vaccinate its citizens first, leading to inefficient distribution. We’ve seen this problem in the past with far less deadly diseases. For example, during the 2009 H1N1 influenza pandemic, Australia was among the first to manufacture a vaccine, but did not immediately export it because the Australian government wanted to take care of its citizens first. The World Health Organization, in coordination with other organizations such as the Coalition for Epidemic Preparedness Innovations, could and should take a leading role in establishing protocols for the unprecedented scale of vaccine production and distribution. This will require establishing a fair and efficient vaccine allocation system.

Rather than withdraw from the World Health Organization, this is the time for America to further invest. And if we make these investments the carrot to push reform, the payoffs could be substantial. Defunding the World Health Organization in the middle of a global pandemic is short-term madness. And forsaking the chance to lead an effort to meaningfully reform the one body that could, under the right circumstances, stop the next pandemic, is foreign policy malpractice.

When COVID-19 crippled a U.S. aircraft carrier, breezed through Border Control, and didn’t respond to Trump’s rhetorical bluster, the president’s national security playbook was left in tatters. Rather than admit that their narrow conception of national defense was wrong, Trump and his allies did what they always do when they conclude that reality is biased against them: they found someone to blame. This time it was the World Health Organization. But the truth is that transnational threats like pandemics are here to stay, and American security will increasingly depend on using our diplomatic heft to strengthen and improve international health organizations like the World Health Organization. It is disturbing that the president doesn’t recognize this fact, and instead sees institutions like the World Health Organization not as a tool to save lives, but to save face.